Quack quack

Good morning. Happy hump day to all, and to all the medical students out there getting ready to take Boards, good luck! I’m going to try and keep the entry today light, although there is something that I definitely want to discuss, and it might be a little heavy, so just stay with me. On to the blog!

It was another fibromyalgia day yesterday, although interestingly, the majority of the claimants complaining of said disease were males (FM is a predominantly female condition). My last patient of the day was a 21 y/o male, who stated that his main complaints were Chronic Fatigue Syndrome, Fibromyalgia and (can you guess it?) depression. His mother accompanied him, and he shuffled into the office, all sweaty and nervous. I had glanced over his chart prior to calling him back, and it said that he received all of his treatment from the Institute of Fibromyalgia and Chronic Fatigue Therapy (name changed), located in another city, and run by a PhD Psychologist and a dentist. As you might imagine, I found this to be rather odd, seeing as dental health and a musculoskeletal disorder have very little in common, at least to my knowledge. He stated that “if I lift anything heavy, I’ll be tired for like 20 minutes afterwards.” Likewise, he stated that he was often too tired to do chores or drive, so he had his parents and friends take him where he needed to go. Sounds nice, right? After some additional questioning, the claimant stated that he received treatment at the Institute once a month, and admitted that he received all of his medication in the mail. This fact alone would have had my “spider senses” tingling, but when I looked at his medication sheet, I definitely realized something was amiss.

As I’ve said before, FM is usually treated with SSRIs, with the occasional pain medication thrown onboard for good measure. Well, this kid had no anti-depressants on his sheet, heck he hardly had any conventional treatments at all. What follows is a list of the medications, and their usage, for his condition.
1. Mobic – chronic pain
2. Tylenol – pain
3. Azithromycin 500mg– to keep the bugs down
4. Midol – pain
5. Depo testosterone injection – hormone issues
6. Natural Cortisol – hormone issues
7. Ambien – hormone issues/sleep
8. Centrum Silver – multivitamin

Ok, well, you might have already noticed some…irregularities, namely the Centrum silver (he’s 22) and the Midol (he’s a he, although it’s basically just Tylenol and a mild diuretic, anyway). As for the other medications…Azithromycin is an antibiotic (it’s the medication in a Z-pack), which is normally taken over five days. In some instances that therapy may be continued longer, but it is definitely not a daily medication. Then there’s the hormone issue – Ambien does not affect hormone levels at all, it works on neurotransmitters in your brain to make you drowsy. Likewise, unless he had some underlying endocrine disorder which he failed to mention in the “do you have any medical conditions” part of the interview, there’s absolutely no reason that he should be taking supplemental hormones like testosterone (a sex hormone) and Cortisol (an adrenal hormone released during periods of stress). In fact, by adding extra hormones, he could possibly be decreasing the amount of hormones he naturally produces, thereby giving his side-effects such as (get ready for this) fatigue, decreased mood and weakness. Hooo boy (or hautbois) I think we might have found the cause of his problems! Never mind the fact that most people feel like crap taking antibiotics, even if it’s only for a week, and 500mg is above the loading (or largest) dose for a Z-pack. Man oh man.

Needless to say, when I performed the Fibromyalgia point tenderness test, he reported 2/18 points tender (you need 11 to be clinically diagnosed). As for the rest of his physical exam, well, it was as normal as can be. I guess the lesson to learn today is to be careful who you get your care from. There are a bunch of people out there who will sell and tell you anything to get a buck. If your “doctor” starts telling you that you have a disease, but you can only order your medication through the mail, I’d be a little suspicious of their training. There was a chiropractor in town a few years ago that stated that he could tell a person’s health by the Red Beaker Test – a test in which he had the patient hold a beaker of red liquid, and based on the way it jiggled, he could tell if you had gallbladder problems, heart disease or even infertility. He offered the test for the low, low price of $25, and wouldn’t you know, it didn’t really tell anything. Amazing, right? I have no idea how much this kid (or his parents, for that matter) was paying each month for treatment, but as the saying goes, “there’s a sucker born every minute.”

And now, for the disability quotes of the day:

Me: “I’m going to need you to bend at the waist to test the range of motion of your back.”
Older, buxom woman: “You’re not going to look down my shirt, are you?”
Me: “Oh no, ma’am, I’m just looking at your spine.”
Woman: “Well you can look, I won’t mind. At my age, it’s all the action I get.”

Me: “I’m going to test your grip strength. Please take my hands and squeeze them.”
Dude: [Squeezing gently] “I’d squeeze harder, but I might make you explode with the force of my grip.”
Me: “I’ll keep that in mind.”

Caveat emptor,
-DD